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Treatment Guidelines

Passive Death Wish

This is a term used by counselors and psychiatrist but unknown to most parents. Passive death wish is a symptom of depression (or perhaps a mixed state) that is similar to but not the same as suicidal thoughts. Passive death wish means that instead of having thoughts of taking action to harm or kill him/herself, the child or teen has thoughts about death and dying that do not involve committing suicide. A suicidal child is thinking about killing him/herself. A child with a passive death wish is thinking that death would be nice, would be welcome, would be a relief or an escape from his/her emotional pain but does not have an intent to do anything to bring about death or a plan to do so. This may take the form of saying, “I wish life was over!” or “I just wanna curl up in a ball and go to sleep forever/for a long, long time.” or “I wanna join Grandma in heaven.” Also, children can sometimes have a preoccupation with death, with or instead of a passive death wish. This preoccupation could include thinking a lot or talking a lot about friends, relatives, or acquaintances who have died, looking up information about death online, or showing a strong interest in music or literature that focuses on death, for example.

Please note that although younger children may have difficulty sharing such thoughts they can can still have them and can even make a suicide attempt if their depression is severe enough. Because they don’t have the vocabulary of an older child or adult, it can be difficult to truly understand what a child means if they try to share such thoughts. Also, please be aware that some clinicians can underestimate the seriousness of such remarks in younger children, assuming that they do not have the means and/or can not plan an attempt, but some children have attempted to jump out of moving cars or jump in front of moving cars, held their breath in the bathtub and tried to drown themselves, or in other ways tried to end their own lives and their suffering.

A passive death wish is a serious symptom and so is preoccupation with death. Both should always be reported to your child or teen’s treatment team. Either can be an early warning sign before suicidal ideas develop. Therefore, if your child or teen is having thoughts of death in any form, you should monitor them closely to ensure their safety and discuss the need for more in-depth treatment with the tdoc and pdoc who know your child. Any suicidal remarks should of course be reported as well. When in doubt, it is better to be overly cautious than to not do enough to protect your child.